People with diabetes can develop a foot ulcer. Older men are more likely to develop ulcers. People who use insulin are more prone to getting a foot ulcer, as are patients with diabetes-related kidney, eye, and heart disease. Overweight diabetics who smokes tobacco and use alcohol also plays a part in the developing foot ulcers.
How does ulcers form?
Ulcers form due to a combination of reasons, such as:
- Lack of feeling in the foot
- Poor circulation
- Irritation (such as friction or pressure)
- Trauma
Patients who have diabetes for many years can develop neuropathy, a reduced or complete lack of ability to feel pain in the feet due to nerve damage caused by elevated blood glucose levels over time. The nerve damage often occur without pain, and one may not even be aware of the issue. Your podiatrist can test feet for neuropathy with a tool called a Monofilament.
Vascular disease can complicate the foot ulcer, reducing the body’s healing system to heal and increasing the risk for an infection. Elevations in blood glucose can decrease the body’s ability to fight off a potential infection and also slow down the healing.
Are there any symptoms?
Many people who develop foot ulcers loses the ability to feel pain, pain is not a common symptom. Many times, the main noticeable thing is some drainage on your socks.
Redness and swelling may also be associated with the ulceration and, if it has progressed significantly, an odor may be present.
Once an ulcer is recognized, seek a podiatrist medical care immediately. Foot ulcers in people with diabetes should be treated to reduce the risk of infection and amputation.
Diagnosis and Treatment
Factors to appropriately treat a diabetic foot ulcer:
- Prevention of infection
- Relieving pressure off the area, this process is called “off-loading”
- Remove dead skin and tissue, this process is called “debridement”
- Applying medication or dressings to the ulcer
- Managing blood glucose and other health problems
Not all ulcers are infected; however, if your podiatrist diagnose an infection, a treatment program of antibiotics, wound care, and possibly hospitalization can be necessary.
To keep an ulcer from becoming infected, people must:
- Keep blood glucose levels under tight control
- Keep the ulcer thoroughly clean and bandaged
- Daily wound cleansing
- Avoid walking barefoot.
For a wound to heal, there must be good circulation to the ulcerated area. Your podiatrist can determine circulation levels with noninvasive tests.
How to prevent a foot ulcer?
To determine if you are at high risk for developing a foot ulcer, here are strategies to prevent a foot ulcer:
- A foot deformity (e.g., bunion, hammer toe)
- History of a previous foot ulceration
- Poor circulation
- Neuropathy
Checking your feet daily is pivotal so you can find a potential problem as early as possible, especially between the toes—for cuts, bruises, cracks, blisters, redness, and ulcers.
References:
- Armstrong DG, Nguyen HC, Lavery LA, et al. Off-loading the diabetic foot wound: a randomized clinical trial. Diabetes Care. 2001;24:1019–22. [Erratum appears in Diabetes Care 2001 Aug;24(8):1509] [PubMed]
- Beckert S, Witte M, Wicke C, et al. A new wound-based severity score for diabetic foot ulcers: A prospective analysis of 1,000 patients. Diabetes Care. 2006;29:988–92. [PubMed]
- Beltran J, Campanini DS, Knight C, et al. The diabetic foot: magnetic resonance imaging evaluation. Skeletal Radiology. 1990;19:37–41. [PubMed]
- Blume PA, Walters J, Payne W, et al. Comparison of negative pressure wound therapy using vacuum-assisted closure with advanced moist wound therapy in the treatment of diabetic foot ulcers: a multicenter randomized controlled trial. Diabetes Care. 2008;31:631–6. [PubMed]
- Bouter KP, Visseren FLJ, Van Loenhout RMM, et al. Treatment of diabetic foot infection: An open randomised comparison of imipenem/cilastatin and piperacillin/clindamycin combination therapy. International Journal of Antimicrobial Agents. 1996;7:143–7. [PubMed]
- Boyko EJ, Ahroni JH, Davignon D, et al. Diagnostic utility of the history and physical examination for peripheral vascular disease among patients with diabetes mellitus. Journal of Clinical Epidemiology. 1997;50:659–68. [PubMed]
- Canavan RJ, Unwin NC, Kelly WF, et al. Diabetes- and nondiabetes-related lower extremity amputation incidence before and after the introduction of better organized diabetes foot care: continuous longitudinal monitoring using a standard method. Diabetes Care. 2008;31:459–63. [PubMed]
- Caravaggi C, Faglia E, De GR, et al. Effectiveness and safety of a nonremovable fiberglass off-bearing cast versus a therapeutic shoe in the treatment of neuropathic foot ulcers: a randomized study. Diabetes Care. 2000;23:1746–51. [PubMed]
